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Indonesia 2018 | HEALTH | INTERVIEW

TBY talks to Dr. Nila F. Moeloek, Minister of Health, on achieving universal health coverage in 2019, becoming more self-reliant in the field of pharmaceuticals, and lowering costs across the board.

Dr. Nila F. Moeloek
BIOGRAPHY
Dr. Nila F. Moeloek completed her medical education at the faculty of medicine, University of Indonesia before pursuing a medical specialty in ophthalmology, in which she earned her PhD at the University of Indonesia. As Special Envoy of the President of Indonesia for the Millennium Development Goals (MDGs) from 2010 to 2014, she successfully initiated and implemented a breakthrough program, Pencerah Nusantara, to reach MDG targets by sending out groups of young health workers dedicated to providing primary healthcare services to remote areas. As a professor at the Faculty of Medicine, Dr. Moeloek has authored or co-authored 250 scientific works.

How would you evaluate the implementation of the national healthcare scheme in Indonesia?

Indonesia has taken significant steps toward universal health coverage through the development of an integrated national health scheme. The social health insurance scheme called National Health Insurance (JKN), launched in 2014. The aim of JKN is to provide all citizens with access to quality health services, including prevention, promotion, treatment, and rehabilitation, while also protecting them from health-related financial hardship. The evaluation of the implementation of JKN includes issues such as membership coverage, healthcare providers, managing finances, healthcare utilization, and healthcare quality improvement. Indonesia has committed to achieving universal health coverage in 2019. In November 2017, enrolled members of JKN reached 183,579,086, a phenomenal achievement and some 73% of the population. Of these, 59.9% are from lower-income groups, 16.1% are informal workers or unemployed, and 24% are formal workers. JKN involves public healthcare providers—community clinics and public hospitals—and private healthcare providers—private and specialist clinics, individual physician practices, and private hospitals—as they are contracted by the Healthcare and Social Security Agency (BPJS Kesehatan). As of November 2017, BPJS Kesehatan had contracted 21,771 healthcare providers across the country, consisting of 5,900 primary healthcare providers and 2,261 referral healthcare providers. In 2016, there were up to 192.9 million visits using JKN, nearly double the 2014 figures. In 1H2017, BPJS Kesehatan reported that the number of healthcare visits under JKN reached 106.2 million, which demonstrates that JKN has succeeded in improving access to healthcare for citizens. In terms of quality improvement, the Ministry of Health has implemented a healthcare referral system to ensure that all healthcare providers have a national standard. All referral healthcare providers must be accredited by 2019, and all primary healthcare providers—public health centers—must be accredited by 2021. The Ministry of Health also set national clinical practice guidelines for both primary and referral healthcare.

How has BPJS Kesehatan contributed to a more inclusive healthcare landscape?

JKN is integrating the many fragmented insurance programs and covering the poor and near poor, civil servants, military personnel, police, pensioners, state enterprises, informal workers, and private formal workers. It ensures that the entire population will be covered under a single national health insurance program and brings Indonesia closer to achieving universal healthcare coverage. BPJS Kesehatan is responsible for managing the national health insurance program. It has been operating as a single payer across the country, and its role is recruiting members, collecting premiums, accrediting healthcare providers, making payments to contracted healthcare providers, and handling complaints. The Ministry of Health, as the regulator, is responsible for setting regulations related to the implementation of JKN. In addition, the ministry is also responsible for ensuring healthcare provider availability, including health facilities, health workforce, medical equipment, and medication, by working together with local governments and the private sector.

How do you envision the role of the ministry in attracting investment into the medical equipment and pharmaceutical sectors?

The Ministry of Health aims for Indonesia to be more self-reliant in the field of pharmaceuticals and medical devices in order to meet healthcare needs at a more affordable price. High levels of imports of pharmaceutical raw materials and medical devices may affect the cost of health services in the event of economic fluctuations at a global level. Indonesia's pharmaceutical industry is promising for both domestic players and foreign investors. The Ministry of Health aims to accelerate these industries' development through its Action Plan for the Development of Pharmaceutical and Medical Device Industry established by the Minister of Health in 2017. According to the Presidential Decree No. 44/2016, foreign pharmaceutical industries that produce patented medication or high technology can use up to 85% of FDI while those that produce pharma raw materials as well as high-tech medical devices can use up to 100%. This investment policy is expected to attract more investment to produce pharmaceutical raw materials and high-tech medical devices as well as reduce our dependence on imports.